Totally Laparoscopic Total Gastrectomy

Abstract

Opening gastrocolic omentum and dissociating to the spleen on the left, we broke left gastroepiploic vessels and cleaned the fourth group of lymph nodes. We dissociated and broken short gastric vessels and got to the upper pole of the spleen. Dealing with antrum of stomach, we broke right gastroepiploic artery and vein with cleaning the sixth group of lymph nodes. After exposing the back wall of antrum, we broken right gastric vessels and cleaned the lymph nodes near porta hepatis. Breaking duodenum at 2 cm from pylorus. We broke left gastric vein and cleaned the eighth group of lymph nodes, and broke left gastric artery with cleaning the firth and second group of lymph nodes. After dealing with the abdominal segment of esophagus, we separated and broke vagus. Following suspending left hepatic lobe, we broke esophagus at 2 cm from cardia of stomach. We took out excised stomach and omentum majus through auxiliary incision, which were checked in pathology. After establishing pneumoperitoneum again, we broke jejunum at 20 cm from TREIZ ligament and link esophageal and small intestine with OVERLAP method, in which collective mouth was manually sutured. We completed side-to-side anastomosis of small intestine at 40 cm from anastomosis and sutured mouth on mesentery of the small intestine with help from auxiliary incision. Surgery over. Key words: Stomach Neoplasms; Laparoscopy; Gastrectomy; Lymph Node Excision